County to assess state of oral care

Closing of public dental clinics has led to a health crisis

November 15, 2010|By Ed Finkel, Special to the Tribune

A consortium of health organizations is campaigning to direct more funding toward dental care for an estimated 1.4 million people in Cook County. There are now only four public dental clinics in the county, along with Stroger Hospital. (Sean Gallup, Getty photo)

Lorraine Tatum rarely had a problem scheduling dental appointments when her older children were in school, but the mother of seven said she struggles to get her three remaining school-age children into the dental clinic in her Englewood neighborhood.

"We could use more than one clinic. You have to be standing outside in line," said Tatum, noting that the weather is turning cold. "It's ridiculous."

The private Reymar Dental Clinic at 6202 S. Halsted St. takes 15 appointments on the weekends on a first-come, first-served basis for people on public aid.

Cook County has just four public dental clinics — in Ford Heights, Maywood, Bridgeview and Rolling Meadows — along with the main county dental office at Stroger Hospital to serve the more than 1.4 million residents registered for government health care. The result is an oral health care crisis, with thousands of residents going without dental treatment or forced to wait months for routine treatment, according to a consortium of health organizations.

Acknowledging the crisis, the Cook County Board recently passed a resolution supporting the coalition's Bridge to Healthy Smiles campaign and directing the county health department to take a complete inventory of dental services. The department is to report back within 45 days on clinic locations, hours of operation, staff at each location, numbers of patients served, wait times and procedures performed, as well as a list of clinics closed in the last decade.

In 2007, the Cook County closed four of its eight satellite dental clinics — in Markham, Robbins, Skokie and South Holland. That was on top of the city shuttering its three clinics last year. The Chicago Department of Public Health refers people to dental schools and other providers of low-cost or free care, said spokesman Tim Hadac.

But the total volume of services has not dropped as drastically as it might seem, said Linda Murray, chief medical officer for the Cook County Department of Public Health. She said the county never had more than six full-time dentists, who used to split time between locations. Still, Murray readily agrees there remains great unmet need.

"We do not value oral health appropriately," Murray said. "All of my colleagues believe we should be offering more dental services. The question is, what is the Board of Commissioners willing to pay for? …

When we talk about rolling back the 1/2 percent (sales) tax, I'm going to tell you right now that means more cuts. The citizens of Cook County have to understand: Is this a basic human service, or is this a luxury?"

County Commissioner Peter Silvestri, who sponsored the board's resolution, said he will wait to hear the department's report before coming to a conclusion but agreed that adding more resources is a possibility — but that could mean cuts in other public health areas that seem less vital.

"If that means realigning existing resources, that's what we need to do," Silvestri said. "If that's not possible because of budget cuts, we will come to that determination." He said the resolution asks for information and is not intended as criticism of the department or its dental services.

"For lack of a better term, it's not a punch in the teeth to anybody," he said.

The consortium of about 30 public health-related organizations and agencies is advocating for reinvestment of public resources to bridge the current gap, which it estimates affects 1 million people in Cook County.

The campaign cites statistics showing that 27 percent of third-graders have untreated cavities, including 36 percent of those in Chicago, and the average wait time for an appointment is two months for general care and a year for specialty care. It also cites a surgeon general's report that links oral disease with ear and sinus infections, weakened immune systems, diabetes, and heart and lung disease, among other conditions.

Murray said that measuring the wait times at public health clinics will not even measure the full extent of the need because the county does not cover anyone who has dental insurance — no matter how flimsy that insurance might be.

"Dental services are one of the things in this country that distinguishes working people and poor people from the upper middle class," she said. "You can frankly tell by looking at (the teeth of) a teenager or young adult how much money their family has."

Resources at the clinics are limited; each has one full-time dentist and no dental hygienist. Stroger, which handles oral surgery, sees only 35 patients per day and the line, which opens at 8 a.m., is usually filled by 8:15, according to the county's Web site and voice mail.

"There's pro bono, a lot of those, but it will never be able to take care of this much need," said Michael Stablein, president of the Chicago Dental Society. "If it's a child, we don't want them to miss school. If it's an adult, we want them to go back to work. If you're missing teeth, it's hard to be able to get certain types of jobs. We're asking for relief of pain and infection. We're asking for a routine appointment within seven to eight weeks."

Dental care is often one of the first things cut when budgets get tight, said Anne Clancy, project director at Chicago Community Oral Health Forum, a project of the Heartland Alliance and a Bridge to Healthy Smiles member group.

"The overhead's extremely high," she said. "When there's issues in county budgets and state budgets and so forth, they look at programs that cost a lot of money and don't necessarily bring a lot of money in."